Inpatients at Baylor Health Care System in Dallas dont have to wait until theyre in crisis to get a visit from a rapid response team.
The team, made up of a nurse, a respiratory therapist and sometimes a hospitalist or intensivist, is available whenever a nurse feels she needs extra help or a second set of eyes and hands with a struggling patient, or when a patient's physician calls in and needs an immediate assessment. Even family members can summon the RRT if their loved one just isn't looking right. Instituted in 2006, the teams have contributed to a 12% drop in inpatient mortality.
"As those RRT calls increase, the number of (cardiac) arrests and codes decreases, and that's been proven nationally," says Rosemary Luquire, chief nursing officer for the system.
Baylor's Web sitebaylorhealth.comlike those of most healthcare providers, has a section called "About Us." But unlike most, the "About Us" section includes a tab called "Quality Data on Core Measures." Click on it to see data from nine of Baylor's facilities on their performance at treating heart attacks, congestive heart failure and community-acquired pneumonia, and at following recommended protocols for preventing surgical infections. Their performance is compared with national averages as tracked by the CMS, and also with Texas state averages, which Texas tracks on its own.View list of judges, past award winners
Baylor uses a product called the Global Trigger Tool, a database that flags and analyzes adverse events such as falls, medication errors and surgical-site infections. While the tool was developed originally by the Institute for Healthcare Improvement, a leader in the healthcare quality movement, Baylor's use of it pushes the envelope in a couple of ways. Baylor analyzes the degree of preventability of each event and what other factors may have contributed to it, such as a malfunctioning safety device or poor communication between caregivers. And while the IHI counts only errors of commission in its adverse-event guidelines, where someone's action results in a patient injury, Baylor also includes errors of omission, where inaction causes damage.
For these accomplishments and for its systematic approach to promoting quality care, Baylor Health Care System is the 15th winner of the National Quality Healthcare Award, presented by the National Quality Forum in partnership with Modern Healthcare and the Studer Group.
"Baylor stood out because the whole organization was solid in terms of acting on its commitment to quality," says physician George Isham, who chaired this year's panel of judges and who's chief health officer and plan medical director at HealthPartners, the Bloomington, Minn.-based managed-care organization that was the 2006 award winner. "That degree of depth and commitment and follow-through isnt as common as we need it to be in healthcare." Baylor was chosen from a field of 10 finalists.
The organization started its current quality push in 2000, on the heels of the Institute of Medicine's landmark report To Err is Human.
"We had always had the perception of being the highest-quality provider in our market, but we wanted to prove it," says Joel Allison, Baylor's president and chief executive officer. People had always talked about quality, but measuring it was the challenge. As we saw more public reporting, we wanted to make sure that the information on us was accurate, and we wanted to be one of the leaders."
When David Ballard, a physician and the system's first chief quality officer, arrived in 1999, one of his first mandates was to lay out a quality-improvement plan for the whole system. That early plan resulted in the formation of the Best Care Committee, a multidisciplinary group of more than 100 people from all the system's hospitals and HealthTexas Provider Network, Baylor's affiliated medical group. Co-chaired by the system's chief medical officer, Paul Convery, and the head of HealthTexas, the group meets every other month and oversees planning, budgeting, execution and reporting on all activities related to improving quality and patient safety. While subcommittees work out the details, the larger group creates the overall organizational approach, according to details from its award entry.
Also starting in 2000, the system began a physician-improvement program, including sending some physicians to courses and meetings presented by external groups like the IHI. Baylor funded these trips, and also paid physicians up to $200 an hour to participate in planning its quality initiatives.
"Physicians are in an eat-what-you-kill, fee-for-service model," and every hour spent in a quality-improvement meeting is an hour when theyre not seeing patients, Ballard says. "We don't fully cover their opportunity cost, but we work hard to make the case that these quality-leader roles are important."